Download
respiratory emergencies n.
Skip this Video
Loading SlideShow in 5 Seconds..
Respiratory Emergencies PowerPoint Presentation
Download Presentation
Respiratory Emergencies

Respiratory Emergencies

961 Views Download Presentation
Download Presentation

Respiratory Emergencies

- - - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript

  1. Respiratory Emergencies Provena Regional EMS

  2. What we know • Air is good • Pink is good • Blue is bad • Air goes in • Air goes out

  3. Ventilation is • Movement of air in and out

  4. Upper Airway • In through nose • Warms • Humidifies • Filters • Past epiglottis • Into trachea • Anterior to esophagus

  5. Sellick’s Maneuver • Pressure on cartilage • Pushes trachea more posterior for visualization of vocal cords in intubation • Compresses esophagus to inhibit vomiting

  6. Bronchi • Branch off trachea • Bronchioles • 33 divisions to alveoli • No air exchange until alveoli • Dead air space • Must ventilate with 500 cc of inspired air to get to alveoli

  7. Alveoli • Elastic muscles around bronchioles can cause spasm • Network of capillaries around alveoli for gas exchange

  8. Exchange of oxygen and carbon dioxide

  9. Ventilation

  10. Mechanics of Breathing • Inspiration chest expands – creates vacuum – air rushes in • Expiration chest contracts – creates pressure – air rushes out

  11. Diffusion– process of moving oxygen into blood and carbon dioxide out • Diffusion is movement of particles (gas) from an area of high concentration to an area of low concentration

  12. Hemoglobin • 98% of inspired oxygen attached to the protein, hemoglobin in RBC alveoli cells

  13. Hypoxia – low oxygen to cells • Causes of hypoxia • Hypoxic hypoxia – not enough oxygen • Anemic hypoxia– not enough hemoglobin • Stagnant hypoxia – not enough perfusion • shock • Histotoxic hypoxia – unable to download • Cyanide poisoning

  14. Causes of Respiratory Emergencies • Failure of: • Ventilation: air in/ air out • Diffusion: movement of gases • Perfusion: movement of blood • Relieved by: epinephrine based medications (such as Beta 2 agonist– albuterol, terbutaline) • Compounded by: • Inflammation/mucus production

  15. Assessment • Scene size up • Scene safety • Environment • What in and around the patient suggests that this is a respiratory emergency?

  16. General Impression of Patient • Position • Color • Mental Status • Ability to Speak • Respiratory Effort

  17. Is this patient in distress?

  18. Look for pursed lip breathing or prolonged expiration

  19. Tripod position suggests distress, resting weight on knees helps with chest expansion

  20. Slow labored breathing is a sign of respiratory failure

  21. Cyanosis – blue discoloration suggests hypoxia

  22. Initial Assessment • Airway – open,no noises • Breathing – 12-20 times per minute • Circulation – warm, pink, dry, strong pulses • Disability – mental status clear • Vital Signs

  23. Focused History • SAMPLE • OPQRST • How long has this been going on? • Start gradual or abrupt • Better or worse with position • Cough • Productive of sputum • Color of sputum– white? Yellow? Red? green? brown?

  24. Additional Symptoms • Chest pain • Fever/chills • Wheezing • Smoking history • Trauma

  25. Medications Currently Taking • Antibiotics • Oxygen • Steroids • Emphysema • Asthma • Inhalers/nebulizers • Emphysema • Asthma • Cardiac drugs

  26. Respiratory Emergencies • For each, consider • Cause/Pathology • Signs and symptoms • Management

  27. Upper Airway Obstruction • Due to • Foreign bodies – food, toys • Tongue • Swelling • Underlying Problem – VENTILATION • Assessment/Associated Symptoms • Airway movement • Ability to speak • Dyspnea • Hypoxia • Sounds – snoring, stridor • Oxygen saturation will be low

  28. Upper Airway Obstruction • Management • BLS– Heimlich maneuver • ALS Foreign Body – Magill Forceps • Allergic Reaction – epi-pen and ALS protocol • Epiglottitis – rapid transport • Croup– humidified oxygen • Sleep apnea– Prescribed CPAP

  29. Emphysema • Destruction of alveolar walls • Underlying Problem: Diffusion • Assessment/Associated Symptoms • Dyspnea with exertion • History of exposure • Barrel chest • Prolonged expiratory phase • Pursed lip breathing • Thin and emaciated • Pink puffer (extra hemoglobin to make up for poor oxygen pick up)

  30. Management • Won’t call till there is a problem • Secure airway • Correct hypoxia • Respiratory drive from low oxygen not high CO2 • IV access (dehydration) • Albuterol for Bronchodilation if wheezing

  31. Chronic Bronchitis • Increased mucus production • Decreased alveolar ventilation • Underlying Problem: VENTILATION AND INFLAMMATION • Assessment/Associated Symptoms • History of long term exposure to toxins • Frequent respiratory infections • Heavy sputum production • Obese and cyanotic (blue bloater)

  32. Management • Secure airway • Correct hypoxia • IV access (dehydration) • Albuterol Bronchodilation if wheezing

  33. Asthma • Lower airway obstruction • Bronchospasm • Edema • Mucus • Caused by • Irritants • Respiratory infection • Emotional distress

  34. Asthma • Underlying Problem: VENTILATION AND INFLAMMATION • Assessment/Associated Symptoms • Non productive cough • Wheezing • Speech dyspnea – one word sentences • Use of accessory muscles • Status Asthmaticus– not responding to treatment

  35. Breath sounds? • IF BRONCHOLES TOTALLY OCCLUDED NO BREATH SOUNDS AT ALL ---SILENCE IS BAD, BAD, BAD

  36. Management • Secure airway • Correct hypoxia • IV access (dehydration) • Bronchodilation Beta 2 agonist • Inhaled, nebulized and/or subcutaneous • Albuterol, terbutaline

  37. Pneumonia • Infection of the lungs • Alveoli and interstitial spaces fill with fluid • Includes Severe Acute Respiratory Syndrome (SARS) and tuberculosis • Underlying Problem: DIFFUSION

  38. Assessment/Associated Symptoms • Looks ill • Fever and chills • Productive cough • Chest pain with respiration

  39. Management • BSI – wear a mask • Secure airway • Correct hypoxia • IV access (dehydration) • If wheezing -- Bronchodilation Beta 2 Agonist -- albuterol

  40. Costochondritis • Viral chest wall pain • Inflammation of muscle walls and cartilage of chest • Underlying problem: VENTILATION AND INFLAMMATION

  41. Assessment/Associated Symptoms • Sudden onset • No trauma • Pain on deep inhalation • Pain on palpation • May have fever or history of cold

  42. Management • Correct hypoxia • Symptom relief • Anti-inflammatory medications • Ibuprofen

  43. Toxic Inhalation • Inhalation of • Super heated air • Chemicals • Combustion products • Steam • Lower airway edema • Bronchospasm • Underlying Problem: VENTILATION, INFLAMMATION, DIFFUSION

  44. Assessment/Associated Symptoms • Nature of inhalant • Burns to face, nose, mouth • Strider

  45. Management • Rescuer safety • Remove from further exposure • Secure airway – may need intubation • Correct hypoxia • IV access • Rapid transport • Correct wheezing with beta 2 agonist-- albuterol

  46. Carbon Monoxide Poisoning • Inhalation of gas that binds with hemoglobin • Underlying Problem: CELLULAR HYPOXIA • Assessment/Associated Symptoms • Headache • Irritability • Errors in judgment • Confusion • Vomiting • Flu symptoms • Pink color

  47. Management • Rescuer safety • Remove from source • Secure airway • High flow oxygen • Hyperbaric chamber

  48. Pulmonary Emboli • Blood clot (or other emboli) in pulmonary circulation blocking blood flow • Ventilation perfusion mis-match • Underlying problem: PERFUSION, DIFFUSION

  49. Assessment/Associated Symptoms: • Sudden onset acute chest pain • Sudden onset acute dyspnea • Tachypnea – fast breathing • Tachycardia – fast heart rate • Recent history of being inactive

  50. Management • Secure Airway • Correct hypoxia • IV Access